Prioritizing problems

Hi everyone. I’m on my cardiopulmonary placement and in the past two weeks I have been exposed to a large range of patients. What I have been learning is that in the process of analysis of patient’s problems, there are a lot of other problems that need to come in the number one of the list, such as pain, anxiety, drowsiness, nausea/dizziness, besides the 10 physiotherapy respiratory problems. I have noticed that either in surgical or medical patients those other problems influence totally in the patients symptoms, therefore in the other problems and, consequently, treatment. Other things like, surgical procedure (complications of, wound, pain Mx) and PMH also play a big role. For example, the patient that I mentioned on my last blog (thanks Peying for the comment) that had really weird responses when I tried to stand him up for the first time, at end I found out that it was pure anxiety. The day after he was mobilizing fine, no problems at all. Another patient that I had today, post-lobectomy, his main problems was drowsiness and nausea. Because of that, it was really difficult to get the patient out of bed. Initially, the drowsiness was the main issue because I didn’t really know how he was feeling and he wasn’t responding much to command. After liaising with nurse, his pain medication was changed and he was more responsive, so we could sit him out of bed. When I came back after 2 hours to put him back to bed, he was extremely nauseous, vomiting after mobilizing. That again, impacted on his progression. At the end, my intervention number one was liaise with staff regarding his medication and then start the deep breathing, SOOB, ambulation…
What I learnt from that is we need to have a big picture of our patients, not only from what we assess, but be aware that we are part of a team that need to work together for the best of the patient.
Good luck on the next two weeks!